Health care reform makes some gains; sign-up deadline looms

ADDISON COUNTY — Two key Addison County lawmakers involved in the state’s health care reform effort said they are pleased with Vermonters’ response to the new health insurance exchange and conceded that long-awaited financial details about the transition to a single-payer system probably won’t be available until early next year.
That was the word this week from Sen. Claire Ayer of Addison and Rep. Mike Fisher of Lincoln, both Democrats.
Ayer is chairwoman of the Senate Health and Welfare Committee, while Fisher chairs the House Health Care Committee. Both are heavily involved in the oversight of Vermont Health Connect and the state’s expected shift to a single-payer system by 2017.
Ayer acknowledged what she called “a lot of glitches” in the on-line registration process for Vermont Health Connect (VHC). Many Vermonters reported problems choosing a plan through the VHC website. Some found their coverage through the exchange was more expensive than their current policy.
“I think we’re getting there,” Ayer said. “To say it’s been a bumpy road has been an understatement.”
She spoke of reports of people registering for a health insurance plan through VHC, making their initial payment for that coverage, receiving a card saying they were all set, and then finding out they didn’t have insurance. Others have sent in a payment for March coverage only to be told their plan would kick in in April.
But Ayer said most clients have been able to correct these glitches with a toll-free phone call to VHC.
Open enrollment for VHC ends on March 31. Each state is bound, by the federal Affordable Care Act, to either build its own health insurance exchange or allow the U.S. government build one for it. Vermont elected to build its own exchange, through which individuals, families and small businesses in the state are expected to purchase their health insurance. Also included in the exchange are citizens who are uninsured, underinsured or who have been clients of subsidized health care programs such as Medicaid, Catamount Health and the Vermont Health Access Program.
Approximately 52,400 Vermonters had successfully picked a health insurance plan through VHC as of Wednesday, according to Emily Yahr, public information officer for Vermont Health Connect. Around 37,400 have gone through the registration process and are officially enrolled, she added. Yahr said she was unable to provide a total number of eligible Vermonters that are expected to register through VHC.
“That’s a moving number,” she said.
“We are really pleased with the progress.”
Ayer and Fisher are also generally pleased with the totals thus far.
“We are told we have the highest enrollment, per capita, in the country,” Ayer said. “We are told we are one of the shining stars in the exchange.”
More than half of those who have registered through VHC have qualified for financial assistance to help pay for their health insurance, according to Fisher. The average subsidy has been $380 per month, he said.
“It’s a level of support that a vast majority of Vermonters didn’t have before the Affordable Care Act,” Fisher said.
“We do have a lot of people who are paying less for better care,” Ayer added. “That was the objective (of VHC).”
Fisher says he’s convinced the state’s health reform efforts are making a difference.
“We believe we are making an impact on the uninsured population,” he said.
Fisher and Ayer are also monitoring efforts to establish a single-payer health care system, called Green Mountain Care, in Vermont. They acknowledged frustration — exhibited by lawmakers and citizens — that the Shumlin administration has yet to propose a financing plan for the system. Act 48, which lays out Vermont’s path to single-payer, gave the administration until Jan. 15, 2013, to provide financial details.
Shumlin is not subject to any sanctions as a result of missing the deadline, according to Ayer.
“The consequences are a number of people bringing it up at every single opportunity,” Ayer said.
Many lawmakers, according to Ayer, have conceded that the deadline prescribed by Act 48 was not realistic, given the magnitude of the information that must be processed.
“(Shumlin) could have given us a financing plan, but it could have been meaningless in two years,” Ayer said. “He’s gotten a political black eye for that.”
“The January 2013 deadline for Green Mountain Care was the wrong date, I acknowledge,” Fisher added.
Ayer noted Shumlin said last week that he is now targeting Jan. 1, 2015, as the date by which he plans to submit his administration’s report on single-payer.
“He said the administration learned a little bit from the roll-out of the health care exchange, and that is not to go ‘live’ until they are ready to go live with certain kinds of programs and data,” Ayer said. “They are being a little more reserved on this.”
Meanwhile, lawmakers are unofficially hearing cost estimates ranging from $1.766 billion to $2.175 billion for the new single-payer system.
So with the incomplete financial picture, current plans call for the Senate to soon approve a health care bill that would cross over into the House this session and feature a “placeholder” for financial details for a single-payer plan.
Ayer believes that this strategy will give the administration more time to see how its recent efforts to cut health care costs — such as the digitizing of medical information — will influence the final expense of a single-payer plan.
“The House and Senate will work together on this,” Ayer promised. “We’ll be set up to say (the governor’s estimates) are not going to cut it, or however we’re going to react to it. He’ll make a proposal to us.”
Asked what taxes the Legislature is likely to consider in financing a single-payer plan, Ayer cited the income tax and a payroll tax. If that indeed proves to be the case, lawmakers will need to figure out how Medicare clients would fit into such a revenue scheme. Most Medicare patients are retired, on fixed incomes and aren’t drawing a salary from which to exact a payroll tax.
And Vermont, the second-grayest state in the nation, is home to many retirees.
“We have to figure out how to do something (for retirees) that’s fair and sensible,” Ayer said. “To me, that’s the toughest piece.”
Fisher said Vermonters should realize that a financing plan for a single-payer system will replace what they are currently paying for private health insurance premiums, which continue to rise much faster than the annual inflation rate.
“It’s really important to realize that these cost estimates relate to what Vermonters are paying on the open market,” he said.
John Flowers is at [email protected].

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